Constipation can be a very disabling symptom. Often all that is needed is an increase in fibre but sometimes this is not effective and different approaches are required...

Indigestion

Indigestion is a general term with no strict medical meaning.


It generally refers to any discomfort in the upper abdomen that relates in some way to meals. The medical term is “dyspepsia”


What causes indigestion?

  • Acid reflux is a common cause.
    • Sometimes there is just heartburn (burning discomfort behind the breastbone).
    • Sometimes there is upper abdominal discomfort as well as heartburn.
    • Sometimes acid reflux does not lead to the typical symptom of heartburn but only causes upper abdominal discomfort.

  • In the past, peptic ulcers (duodenal and gastric ulcers) were a common cause of indigestion.
    • This diagnosis has become much less common.
    • This is because of decreasing numbers of people infected with bacteria called Helicobacter.
    • In addition, there is now effective antibiotic treatment for people with “indigestion” symptoms who have been found to be infected with Helicobacter.

  • Symptoms of indigestion are usually frequent, often daily.
    • This is contrast to gallstones which cause less frequent "discrete" episodes of pain.
    • With gallstones there may be a clear pattern of discomfort (with or after the meal) that is repeated in a stereotyped fashion.

  • If there is prominent bloating or abnormal fullness after meals or nausea this is more likely to be due to a motility disorder or associated with irritable bowel syndrome.



Investigation

  • The main investigation for indigestion is a gastroscopy.
    • This is a simple outpatient investigation that provides accurate inflammation on the oesophagus, stomach and duodenum.
    • A barium meal is very rarely indicated and is much less reliable.

  • The gastroscopy may show;
  • Sometimes an abdominal ultrasound is required to exclude gallstones.
  • What is the problem if the gastroscopy is normal?
    • If the gastroscopy is normal then this provides helpful reassurance.
    • The diagnosis may be acid reflux. Only 1/2 of the time is there positive evidence of reflux on gastroscopy.
    • The diagnosis may be a “sensitive stomach” or a motility disorder.
    • This can be termed non-ulcer dyspepsia or functional dyspepsia. These "medical" terms can not hide the fact that not much is understood about some “indigestion” symptoms. There is an association with irritable bowel syndrome.



Treatment

  • Treatment of heartburn is more straightforward.
    • Refer to treatment section in heartburn article.

  • Treatment of indigestion when the gastroscopy is normal is more difficult.
    • A trial of Losec (omeprazole) or Somac (pantoprazole) is worthwhile to see if acid reflux is part of the problem.
    • A trial of tablets to improve the emptying of the stomach is worthwhile particularly if there are symptoms of bloating or fullness after meals. The best medication is Motilium (domperidone) taken ½ hour before meals.
    • Helicobacter, if present, should be treated but this may not make a major difference.
  • Dietary changes can help.
    • Important changes may be stopping coffee and alcohol intake intake which sensitize the lining of the oesophagus and stomach.
    • See section in heartburn and irritable bowel syndrome.

  • There may be a major contribution from stress.
    • The reassurance from a normal examination of the stomach (gastroscopy) may be enough to decrease the impact of the symptoms on daily activities.
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